2020 Certification Standards for Audiology: Clinical Simulation
On April 1, 2020, the Audiology Committee of the Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) approved a temporary expansion of the definition of audiology clinical simulation, which was extended many times due to the COVID-19 pandemic. On July 30, 2021, the CFCC approved an expansion of the simulation definition without an expiration date and this expansion is no longer tied to the COVID-19 pandemic.
Clinical Simulation (CS)
CS is the use of alternative methods of clinical practicum. In 2020, the CFCC revised the Audiology Certification Standards to include the use of CS as part of Standard III. In this revision, the CFCC gave programs accredited by the Council for Academic Accreditation in Audiology and Speech-Language Pathology (CAA) the option of obtaining up to 10% supervised clinical experience through CS. This option allows students to use CS to obtain a sufficient variety of supervised clinical experiences in different work settings, with different populations, regardless of geographic location. Additionally, CS provides another resource for students to use to develop clinical knowledge and skills.
CS may include the use of standardized patients and simulation technologies (e.g., virtual patients, digitized mannequins, immersive reality, task trainers, computer-based interactive). These supervised CS experiences under an ASHA-certified audiologist can be synchronous simulations (real-time) or asynchronous (not concurrent in time) simulations. Up to 10% of an applicant’s supervised clinical experience for ASHA certification can be obtained through CS. CS experiences for ASHA certification can only count when obtained within the doctoral program at the discretion of the CAA-accredited program.
Case discussions in which the student is asked to make evidence-based recommendations for procedures, and to predict and analyze results, may be live with a clinical instructor or may include written responses with a debrief with the clinical instructor.
All CS cases should be viewed and treated in the same manner that they have traditionally been through didactic and clinical experiences with live patients. Watching a live or recorded video is not an example of a CS and observational experiences (i.e., video clips, watching live or recorded sessions) do not meet the criteria of CS. Observing sessions and watching videos are valuable educational experiences but, as always, they cannot be counted as direct clinical contact.
CS Clinical Instruction
Clinical instruction presents in many forms and it includes a debriefing component for the purposes of meaningful learning. Clinical instruction can be asynchronous or synchronous. In the instance of a virtual client, debriefing sessions should be conducted after the completion of the CS in order to meet the 25% observation requirement. For example: Student A can complete a simulation for 60 minutes, followed by a 15-minute debriefing with the clinical educator, and receive credit for a 60-minute session that was observed 25% of the time.
CS Debriefing Activities and Supervision Requirements
Debriefing activities may include face to face discussion, self-reflection with feedback, and/or written self-evaluation with feedback. Debriefing can meet the 25% supervision requirement in asynchronous learning situations. In synchronous learning, the observation is taking place while the student is completing a task with either a live patient or with a simulation, such as a virtual mannequin.
Minimum supervision requirements apply to CS, and 25% of a student’s total contact with each client or patient must still be met. In a typical 60-minute session with a standardized patient, the clinical instructor must observe 15 minutes / 25% of the session). While additional time may be spent debriefing as part of clinical education, the additional debriefing time could be part of your clinical instruction plan.
If simulated cases are treated like "live" clients/patients, the percentage of supervision required for simulated cases is 25% of the total patient clock hour time.
Computer-Based CS
Students do not need to be supervised while they are completing computer-based CS tasks; often, the clinical instruction occurs asynchronously followed by debriefing sessions.
When using computer-based CS, it is important to track the clock hours the students spend completing each session. The time students spend on CS can vary greatly, particularly at the beginning of their clinical practicum experiences. Companies who provide CS technology often publish the average amount of time to complete each session. If there is no such time published, an academic program can (a) determine the average time that the majority of the students spend on each simulation, given the cohort and the simulation itself, using the clinical instructor’s judgment; or (b) make its own determination and apply it fairly and equitably.
If an entire class of students is simultaneously accessing one CS case, the clinical instructor should observe these students as if they were a group of students completing "live" cases. Structuring this situation as an asynchronous learning task would be a good approach.
One of the benefits of having access to CS is the ability to complete the same CS case multiple times, particularly in an area in which a student is struggling. While students do have the option to complete the same case several times for practice as the immersive experience of repetitive practice is highly valuable, clinical hours can only be counted once.
